Provider Demographics
NPI:1851060420
Name:STEELE, SHAUNTEL (OD)
Entity Type:Individual
Prefix:
First Name:SHAUNTEL
Middle Name:
Last Name:STEELE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 DOUGLAS ST APT 1
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-4201
Mailing Address - Country:US
Mailing Address - Phone:360-903-3698
Mailing Address - Fax:
Practice Address - Street 1:15901 SW JENKINS RD
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97006-5045
Practice Address - Country:US
Practice Address - Phone:503-641-6023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORATI4599152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist